4 ideas for drastically reducing health care spending

Othman Laraki,

Contributor

Jul. 29, 2017, 8:21 AM

Mark Wilson/Getty Images The current U.S. healthcare debate expends too much energy fighting over who should pay for (and benefit from) the ever-rising cost of healthcare, and spends too little effort exploring the tremendous opportunities to improve the system that lie within our reach.

As Congress prepares to head out on summer recess, here are four proven, effective, and resolutely non-ideological ideas that our representatives might consider reading about that could improve individual health outcomes and reduce health costs.

1. How can we promote prevention & early detection?

By far the most effective (and fiscally efficient) way to survive a disease is to not get it in the first place. Catching it early runs a close second.

Today, though, just 3% of our healthcare money is spent on prevention. It's hard to overstate how much this costs, in lives and money. In 2016 the U.S. spent $766 billion dollars on cancer treatment, much of it focused on late-stage disease that could have been detected earlier with targeted screening. Detecting all those cancers just one stage earlier would have doubled the survival rate and reduced spending on cancer by 30%. For breast cancer alone, we would have saved more than $5 billion and 22,000 lives — a greater impact than any therapy in the history of cancer.

Thanks to genomics and other technologies, the human body is no longer a black box. We have the technology and evidence-based medical guidelines to know how to effectively target various aspects of prevention, including the most common hereditary cancers. What we don't have is public policies that encourage its usage.

It has been shown, for instance, that the BRCA1/2 universal screening — a genetic test for the two most common genetic mutations that raise the risk of breast cancer — is cost-effective. But major insurers don't yet cover the test, and Medicare and Medicaid are actually statutorily excluded from paying for preventive testing.

How about a public discussion of what it would take to enable every American to benefit from the health data in their own genome?

2. Why is medical data still not portable?

Speaking of benefiting from your own data — when you find yourself in the ER with a bad flu or a broken arm, why is it so hard for the doctor to learn your blood type, allergies, medications and other relevant information? We tend to think of healthcare reform first as a medical problem and second as a policy problem, but in crucial ways it's really a data problem. The problems caused by the unavailability of individual health information play out in different ways every day, at great cost in jeopardized lives and misspent money.

Don't believe the pushback that making this data readily available would take years and cost billions while posing huge privacy risks. The real problem is that EMR (electronic medical records) systems are designed to protect their owner's customer base; if I make it impossible to quickly and cleanly extract data, I can keep providing lousy service without worrying about you switching to a better vendor.

So, Congress, why doesn't the U.S. have a set EMR mechanism with which every hospital, medical professional and healthcare service must comply? Giving various vendors access to one's medical profile — both to find data and to add it — should be as easy as letting apps connect to your Facebook profile. If we can do this for sharing photos with friends, we can do it for life-saving medical info, without sacrificing people's privacy.

3. How should the FDA adapt to the era of precision medicine?

The FDA has long been the gold standard for the introduction of safe, effective medical therapies. But this system has always been optimized for mass-market healthcare (authorizing drugs to be used by millions of people) rather than products that might only benefit 10,000.

Today our government has a huge opportunity — and a huge need— to promote the emerging marketplace for customized services and therapies. The FDA has begun to introduce initiatives like PrecisionFDA , which are explicitly designed to promote more dynamic health services.

We already have mountains of scientific insight that aren't yet being used at scale. We need to turbocharge these efforts by making it a top priority to figure out how to update regulation to accommodate a data-driven world where every individual is their own study panel.

4. How can we extend insurers' time horizons?

In a market-based healthcare system, insurers' average time horizons are unhelpfully brief. During your work life, an insurer expects to have you on the books for only three to five years before you switch to a new company. Why should they invest in your health 20 years from now?

We need to debate how to incentivize insurers to invest in their customers' long term health. There are plenty of ideas floating around healthcare policy circles. For example, should insurers get "social credits" for helping their members lose weight, sleep better or stop smoking?

There you have it: four ideas that promise to dramatically cut healthcare spending while (gasp) actually helping people live healthier. Two goals that politicians of every stripe should be able to get behind.

Othman Laraki is co-founder and CEO of Color. As an early product manager at Google, he lead Google's performance infrastructure and client-side products. Following Google, he co-founded MixerLabs, which was acquired by Twitter in 2009. At Twitter, Othman was Vice President of Product, helping create the revenue products and grow the user base from 50 to 200 million users. Othman holds degrees in computer science and management from Stanford University and MIT.